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Comment by coliveira | Hacker News Reader

Kudos to the MIT group, but I think the problem of ventilator shortages has nothing todo with technology (this is old, well understood tech), but the lack of leadership in mobilizing industrial production to supply this lifesaving equipment. Since the early days of this crisis this country should had mandated companies to produce record levels of ventilators, masks, vests, and other equipment that are now needed to save lives. On the contrary, the federal government is up to this point dilly-dallying about how to procure and produce ventilators, without a clear solution in sight.

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There are multiple university projects out there: https://www.coresponse.rwth-aachen.de/cms/~gqged/Coresponse/...

Currently also at least the 3d prototyping facilities of automotive manufactures are being used for such purposes.

However, I really want to see those devices saving lives instead of generating news reports.

We already have shortages of intensive care in the grand est and in Italy. I don't think people there have the time to read tech reports and try out all the design.

As far as I understood it, the commercially available ventilators are too complicated to ramp up production quickly. Patents and regulation also complicate things.

This device doesn't have that problem. I can recognize most components as either off-the shelf or easily manufactured.

>>As far as I understood it, the commercially available ventilators are too complicated to ramp up production quickly.

Very true, but USA, China, EU, Russia, India etc have their militaries ready to go with Plan A, B and C, they don't order bullets once invaded.

We all knew that pandemics are part of life, so we should have had warehouses full of this stuff. USA is spending about $700 BILLION a year in military matters and untold trillions in Afghanistan and Iraq. So, at least USA does not need an open source one, we can afford to pay whatever price they sell it for. They neglected this and of course now it's too late. 100K ventilators at, say,$25K each = $2,500,000,000 unless I made a mistake. What's $2.5 Billion to USA?

$2.5 Billion is a lot to the US, especially if it's taxpayer money for a public health issue.

But actually pretty much all countries have stumbled into the same problem. A respiratory pandemic of this magnitude wasn't anticipated by anyone, for reasons that should be investigated further. Now it's very easy to say there should have been a bigger stockpile, but a lot of the voters, especially in the GOP are quite sensitive to government spending, especially for healthcare.

And it's important to remember that there are probably other things countries need stockpiles of, with a similar anticipated risk. For example dialysis machines for a kidney disease pandemic. These things add up quickly, and all you can do is make an educated guess of how far to anticipate any such threat.

No, $2.5Bi is not a lot of money to save thousands of lives. The US wastes untold billions of dollars with war equipment that will probably NEVER be used, on a yearly basis.

Again, politically, for this particular purpose, and on a risk that was considered extremely low, this kind of amount is a lot. And it wouldn't be enough to solve or avert the crisis.

Actually it is not a lot, considering. But looks like prices are down, Pentagon bought 8000 of them for $84M. https://apnews.com/1fd6413c9615da74d44d971075ebf4ff You'd stagger the purchases so not every possible thing is bought at once. Or offer 50% of cost to states if they commit to buy xxxx machines over y years.

For scale: Hospitals got some $100 BILLION from Congress for CoronaVirus.

> A respiratory pandemic of this magnitude wasn't anticipated by anyone, for reasons that should be investigated further.

Right, we had close calls in the near past, but why did they not spread like this one?

Due to combination of enormous containment effort and luck. And of course a crisis averted becomes a source of Internet jokes rather than a lesson in preparedness.

But you can't be lucky all the time.

I'd say the "near-misses" were a few orders of magnitude less severe.

This virus is extremely uncommon in that it is both severe, highly transmissible and a completely new type of virus.

I really don't think most people in developed countries would have agreed to spend a couple Billion Dollars to have reserves in the healthcare system, including ventilators, hospital beds and personnel, in order to prevent a problem a couple of magnitudes bigger than anticipated.

Plenty of people anticipated this given the many near misses we've had since the 1918 pandemic. But there's no money in preparing for pandemics.

> I think the problem of ventilator shortages has nothing todo with technology

isn't the problem economy of scale? at peak, the US needs 25k-30k ventilators for a few days, and then 90 days later we don't need anywhere near that number. where do we store them? how do we justify the expense? etc.

especially if 70-80% of people who still get a ventilator die [1] https://news.ycombinator.com/item?id=22730622

> where do we store them? how do we justify the expense?

You either store a large surplus of them in warehouses, or ensure you can rapidly manufacture them even if the world around you goes to hell. That should be the responsibility of governments, and it's one of the main reasons to even have one - a government doesn't have to justify everything in terms of costs, it can evaluate some non-profit metrics like, I don't know, saving lives in case of emergency. Alas, something happened after the Cold War, all western nations went collectively insane, and got rid of most emergency surpluses and any kind of buffer in the system.

> at peak, the US needs 25k-30k ventilators for a few days, and then 90 days later we don't need anywhere near that number.

Those numbers are way off. NYC alone needs 30k machines.

How exactly do you mandate companies produce something which they don't even have the parts to make? The problem is not manufacturing capacity or will, it's that supply chains for medical devices are global and those supply chains have been broken. Increasing production of something like ventilators purely domestically requires increasing (or building from scratch) production of the components, which requires new or re-tooling, sourcing of raw materials, etc.

Yes, the current federal mismanagement of the whole crisis is awful, but even if everyone had acted quickly, there would still be shortages. Covid spreads faster than device production.

The federal government needed to act as a facilitator, connecting manufacturers with ventilator companies or other experts in medical device manufacturing.

With the supply chains broken, work could have started to bring up new domestic part manufacturers. If all medical device manufacturing was prioritized, lead times would probably shorten to weeks, not months. This is happening by industry already, but again the federal government's facilitator role could definitely speed it up.

Even in a crisis, there are business interests that need to be looked after. A company can't simply decide to stop making parts for its customers and shift to making medical device parts. It would probably soon run out of money and not be able to pay its workers. Here the federal government could eliminate business risk by giving out loans/grants for retooling and guaranteeing the purchase of parts that are made.

This is, in fact, something the federal government is historically quite good at. The Apollo program was (from the NASA side) primarily an organizational project. The feds have traditionally been in a unique position to do global information-brokering.

I can guarantee you that this country has the industrial capacity to produce any kind of parts, especially for a well known technology like ventilators. The fact is that they are not doing it because nobody alerted and told them to do so three months ago.

I'm not convinced that it would have been reasonable to do so three months ago. Three months ago there were rumors that there was something brewing in some part of China most people had never heard of.

I point this out to suggest that your expectation might be a little unfair. If such an order had gone out one month ago it would have been controversial. But if you want to say that the administration is a month behind in their reactions it would be more fair.

You seem to have observed that a giant beauracracy is reacting weeks behind a crisis and this seems to upset you.

3 months ago 5K people were infected in a single day in China. The current administration was completely trained on how to handle a pandemic right after the inauguration. Unfortunately most of those folks have been fired and 3 months ago we were distracted by yet another scandal this time ending in Impeachment.

However 2 months ago this was the message from the White House: 'When you have 15 people, and the 15 within a couple of days is going to be down to close to zero.'

That un-fucking-believable 'head in the sand' moment happened at peak infection in China; 80K people infected. This administration isn't a month behind; they simply don't deal with things unless they are forced to.

The US stockpiles ventilators for emergencies like this for a reason. Someone was asleep at the switch in our Federal Government and the reaction is to lie about how well they are doing and blame everyone else.

I'm fed up, aren't you?

3 months ago the first four cases walked into a hospital in China.

I don't want to defend the current US political powers. I'm highly discouraged about a lot of things. But it doesn't help to make unfair accusations based on bad facts. If your criticisms are based on fiction they get tossed out.

Just rebase on truth and you might have some much more supportable criticism. There's plenty to legitimately criticize. When you drown out legitimate criticism with baseless criticism, the noise to signal suppresses real criticism. It is unclear whether this is intentional.

> Three months ago there were rumors that there was something brewing in some part of China

I disagree. Anyone paying attention knew, in the first weeks of January, that something very dangerous was happening. Moreover, we cannot equate the US government to a common person. They have the most expensive intelligence apparatus in the world. And we have an expensive government exactly to protect the population against real threats like this.

Congress was even briefed as such. They then went and sold their stocks, while downplaying it to the rest of us.

AOC is right, it's time to make stock trading flat-out illegal for members of congress. They hold index funds or nothing.

They should also be restricted to buying/selling with a 1-2 quarter lag on the buy/sell order to prevent them from dumping the indexes when they learn of something that will move the entire market like the current situation.

They could have dumped their index funds for cash for a huge profit.

"The giant bureaucracy" isn't the problem, in itself.

The current administration in the white house, however, is.

A lot of factors came together, hampering the response. Trump has fired lots of experts, many others left for other reasons and Trump has problems hiring Replacements. He disbanded that office in the White House. On top of that he didn't take the issue seriously at all.

I would say that in early January it wasn't yet clear this would become a serious respiratory pandemic. Maybe not even to US intelligence services or the Chinese government. But late January and early February it dawned on most people (including me).

EDIT: I am wrong and can't add. Jan 30th was two months ago. Leaving this here to remind me not to post on HN pre-coffee.

> Three months ago there were rumors that there was something brewing in some part of China most people had never heard of.

Three months ago was January 30th. The number of cases on that date was 7,711 and the number had been increasing at roughly 50% every day for WEEKS at that point.

https://en.m.wikipedia.org/wiki/Timeline_of_the_2019–20_coro...

Three months ago was December 30.

"On 29 December 2019, a hospital in Wuhan admitted four individuals with pneumonia and recognized that all four had worked in the Huanan Seafood Wholesale Market, which sells live poultry, aquatic products, and several kinds of wild animals to the public."

http://weekly.chinacdc.cn/en/article/id/e3c63ca9-dedb-4fb6-9...

Please please please don't make me defend people I don't want to defend.

Thank you. I can't add, at all.

I am going to edit the post to permanently enshrine my inability to do basic math. :)

That’s why we had people embedded in the health services in China. To get warnings on this kind of event far in advance.

The capacity is not fungible, even if with force of law. Further, even if this had been started 3 months ago, I sincerely doubt that the work would be bearing much fruit even now.

Ventilators, generally, may be "well known", but the design and operation of a modern ventilator is probably not something that is "well known".

Doing this kind of stuff is much more complex than our ability to scramble. The key is to think about this kind of crap before it becomes necessary. Without that, we won't have what we need on time. Things like this are just not solvable by throwing money at it after the fact.

Two months earlier means two months earlier, even if it's "not in time" to prevent all shortages.

You issue an emergency procurement. The Federal government has the added power of mandating action.

Will it ship Amazon Prime? No. But you'll be surprised how quickly people will deliver.

You don't mandate as much as you put out an offer. With the right incentive pretty sure many companies could switch to produce these items. And that's the point, it takes time to set up a production line, and the main reason why the government should have acted before.

It would've been nice if the thing the Government _did_ do before this had worked out. Instead, a large company bought the awardee and they requested the government cancel the contract, which resulted in a re-award and... no ventilators yet: https://www.nytimes.com/2020/03/29/business/coronavirus-us-v...

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